Keeping India polio-free at Maha Kumbh

Millions of Hindu devotees have been gathering every day for the last six weeks to bathe in the river Ganga, a purification ritual during the Maha Kumbh Mela in the ancient city of Prayagraj in Uttar Pradesh. According to the Government of Uttar Pradesh, , around 400 million people are estimated to visit the Maha Kumbh Mela from India and overseas between 13 January and 26 February, an auspicious period in the Hindu calendar (panchanga) occurring after 144 years.

Devotees bathing in the river Ganga during Maha Kumbh Mela at Prayagraj (Photo: Alok Kumar / © WHO India)

The last case of wild poliovirus was reported in India on 13 January 2011, and India and WHO Southeast Asia Region were certified polio free in 2014. Since wild poliovirus remains endemic in neighboring Pakistan and Afghanistan, India continues to implement protective measures to maintain its polio-free status through annual polio campaigns to immunize children against polio and keep immunity levels high, conducting AFP and environmental surveillance, and implementing border vaccination to prevent importation of infection, to name a few. WHO is supporting the Government of India in strengthening environmental surveillance for wild poliovirus and vaccine-derived polio virus (VDPV).

Under environmental surveillance for polio, sewage runoff is tested to isolate wild poliovirus and VDPV that are shed in the stool of infected persons who may not have symptoms of the disease, which include high fever, muscle stiffness and acute flaccid paralysis (AFP).

Government officials collecting sewage samples during Maha Kumbh at Mori pumping station on 30 January under the supervision of WHO National Public Health Support Network (Photo: Kanhaiya Dubey / © WHO India)

WHO National Public Health Support Network (WHO-NPSN) is continuing to support the Government of India in investigating acute flaccid paralysis (AFP) symptoms in children to rule out polio infection. Environmental surveillance helps to detect new emergence or international spread of polioviruses before a case of paralysis appears. WHO-NPSN field unit in Prayagraj supported the district health department in conducting environmental surveillance activities at the Maha Kumbh Mela. WHO team also worked closely with the health department in identifying a strategic site for sample collection, maintaining the quality of samples collected, and ensuring its timely dispatch for testing to the designated laboratory at Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow.

Planned environmental surveillance is an ongoing activity at the pre-identified sites of Gaughat and Ghaghar Nala in Prayagraj for sampling, with the health department collecting sewage samples on the first and third Monday of every month under the supervision of WHO-NPSN team, comprising a surveillance medical officer and a field monitor.

Sewage samples are sent to the designated laboratory in the state capital of Lucknow for environmental surveillance under the supervision of WHO National Public Health Support Network (Photo: R. K. Pandey / © WHO India)

Apart from routine environmental surveillance for polio, additional sewage samples are being collected a day after each of the five most auspicious days for ritual bathing in January and February, when there is a surge in the number of devotees gathering at the river banks. Sewage samples on these days are also collected from an additional site at Mori pumping station, where the night soil from temporary lavatories at Kumbh Mela is being evacuated.

WHO has supported the Ministry of Health & Family Welfare in the development of mass gathering surveillance module for the Integrated Disease Surveillance Programme-Integrated Health Information Platform (IDSP-IHIP) for early detection and response to potential outbreaks through near real-time data collection and analysis. The mass gathering surveillance module, which was used during Kumbh Mela 2019, Amarnath yatras, among others, is also being used at the Maha Kumbh Mela.

Crowds heading towards the river Ganga at Maha Kumbh Mela (Photo: Jeevan Pandey / © WHO India)

“Protecting public health at such a massive gathering is no small feat. Ensuring the safety of millions of pilgrims requires planning, preparedness, and unwavering commitment. Identified health conditions are reported to the IDSP-IHIP module daily from health facilities at the Maha Kumbh Mela, and WHO-NPSN teams are supporting the state in the surveillance of polio and other vaccine-preventable diseases. From supporting disease surveillance to vaccination and emergency response, WHO is committed to all efforts to safeguarding public health and preventing the spread of diseases,” said Dr Roderico H. Ofrin, WHO Representative to India.